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Visualize Granularities ofVisualize Granularities of Clinical Data and Affect ChChange
Thomas Carlough, PharmDPharmacy Services Data Coordinator
© Atlantic Health System, Inc. 2015 All Rights Reserved
Oh the things we’ll talk about
1. Suffer the Past ProcessesWalk through the technology and process before we adopted McKesson Analytics Explorer TM
2. Celebrate the Present SolutionsSee the insights that our team was able to describe with better visualizations
3. Explore the Future PossibilitiesLook at what we are planning for the future of this type of data visualizingg
© Atlantic Health System, Inc. 2015 All Rights Reserved
Atlantic Health SystemNorthern New JerseyNorthern New Jersey- 4 Medical Centers
- Morristown Medical Center- Overlook Medical Center
N t M di l C t- Newton Medical Center- Chilton Medical Center
© Atlantic Health System, Inc. 2015 All Rights Reserved
Should you listen to me?//aboutme//aboutme
Background in Computers• Programming since 1995
Background in Healthcare• Working for hospitals since 2004
Background in Informatics• 4 years Healthcare Informatics experience• Professor of Medical Informatics with Farleigh
Dickenson University in NJ
© Atlantic Health System, Inc. 2015 All Rights Reserved
Other More Tangible Objectives
Understand the value of analytics and data visualization for clinical services
Discover how data visualization can allow you to more quickly identify process issues
Realize the power of combining multiple data sets into a single analysis to achieve greater altitude over a complex situation
© Atlantic Health System, Inc. 2015 All Rights Reserved
So… Where do We Start?
Larisa Koshkina: http://www publicdomainpictures net/view image php?image=57458&picture=roadLarisa Koshkina: http://www.publicdomainpictures.net/view‐image.php?image=57458&picture=road
The Joint Commission (TJC) Center for Transforming Healthcare (CTH):for Transforming Healthcare (CTH):Safe and Effective Insulin Use
Aim to solve critical safety and quality problems in healthcare
Solutions are created using systematic approach to process breakdown (Six Sigma)
9th project by the CTH of which Morristown Medical Center (Atlantic Health System) is 1 of 5 participants
What was the big question this project was trying to answer?
© Atlantic Health System, Inc. 2015 All Rights Reserved
Why, Oh Why?
This is important:• > 1 in 5 patients have diabetes (Common)• Insulin errors can be life threatening (Dangerous)
Why, when surrounded by healthcare professionals, do patients go hyper and hypoglycemic?
Source: Joint Commission Center for Transforming Healthcare CTH Insulin Fact Sheet :: http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_Insulin_Fact_Sheet.pdfRetrieved 6/26/2015
© Atlantic Health System, Inc. 2015 All Rights Reserved
Patients in Defect Status?
It sounds cold; but its just Six Sigma
Any Blood Glucose• > 180• < 70
Paul Brennan : http://www.publicdomainpictures.net/view‐image.php?image=89051&picture=patient‐sign‐at‐hospital
© Atlantic Health System, Inc. 2015 All Rights Reserved
Data We Have, Data We Need
We have:• Laboratory Data: BG Result, Date/Time
We need to identify only:
• Inpatients• Those on Insulin• Adults Only
© Atlantic Health System, Inc. 2015 All Rights Reserved
Data Issues
Lab data and PIS data, but cannot be directly combined
Lab data has BG results
PIS has patient information and medication orders (Inpatient/Adult/Insulin)
No way to use SQL to query both at once since data access was not universal
How can we do a crosswalk?
© Atlantic Health System, Inc. 2015 All Rights Reserved
Excel!
Old School
VLOOKUP
Not a bad option if you are doing it one time
Not sustainable
Petr Kratochvil :: http://www.publicdomainpictures.net/view‐image.php?image=5406&picture=telescope
© Atlantic Health System, Inc. 2015 All Rights Reserved
The Fun Part Take this list of 77 data points and then correlate on defect status
© Atlantic Health System, Inc. 2015 All Rights Reserved
Celebrate the Present
Now you know how it “worked” for version 1
Let’s look at what wecan do with better tools
© Atlantic Health System, Inc. 2015 All Rights Reserved
Starting from the Top
The most important data point was the POC glucose result
Over 16 months: 520,875 results
Now in the improve phase• Were We Improving?• Holding Steady?• Were We Regressing?g g
© Atlantic Health System, Inc. 2015 All Rights Reserved
Defect Rates (Cross Tab)
This doesn’t look like much I know but the raw data lays just below the surfaceraw data lays just below the surface
234,742 blood glucose measurements
© Atlantic Health System, Inc. 2015 All Rights Reserved
Defect Rates (Simple Stratification)
B th By month
© Atlantic Health System, Inc. 2015 All Rights Reserved
Mean POC by STAYMean POC by STAY
It is just as easy as it sounds
Pivotting the data to aggregations (instead of raw data points)Pivotting the data to aggregations (instead of raw data points) More concise population metric for a patient Think of this as their “Final Course Grade”
© Atlantic Health System, Inc. 2015 All Rights Reserved
Mean POC by STAY
Pretty successful over the course of a hospitalizationTime to get down from the 30,000 foot view
© Atlantic Health System, Inc. 2015 All Rights Reserved
Mean POC by DAY My initial thought (remember I was a newbie to this) was “tricky tricky”.
You can pivot with two row IDs Hospital # Lab Date
© Atlantic Health System, Inc. 2015 All Rights Reserved
Mean POC by DAY
Wait
Look at the difference
Questions abound, hypotheses?
© Atlantic Health System, Inc. 2015 All Rights Reserved
Patient Trend Mean (Patient Detail)
Patient Joe Smith
© Atlantic Health System, Inc. 2015 All Rights Reserved
Hospital Day Mean
Here’s all of our patients in aggregate.The X Axis is by “Hospital Day”
Sliding Scale Insulin?
© Atlantic Health System, Inc. 2015 All Rights Reserved
Glycemic Events
Hyperglycemic Events >>>(frequency)>>>
Hypoglycemic Events
Extreme Hyperglycemic Events• >300 BG – Potential clinical sequelae
© Atlantic Health System, Inc. 2015 All Rights Reserved
Easily Maintained within the Data Set
The use of the “Calculated Column” feature was utilized to produce four columns• Hyperglycemic Events: If(Lab.Result>180,1,0)• Hypoglycemic Events: If(Lab.Result<70,1,0)• Extreme Hyperglycemic Events: If(Lab.Result>300,1,0)• Severe Hypoglycemic Events: If(Lab.Result<50,1,0)
© Atlantic Health System, Inc. 2015 All Rights Reserved
Easily Maintained within the Data Set
The result was an integer between 0 and 1, 1 if the event existed and 0 if it did not
Using this method allowed us to add a summation to our pivot for our populations
© Atlantic Health System, Inc. 2015 All Rights Reserved
Time to Expand Our Reach
Encounter Data• Includes bed management / registration• Includes diagnoses• Includes prescriber detail
Clinical Data• Includes home med list• Includes MAR• Includes electronic form usage statistics• Meal Data
© Atlantic Health System, Inc. 2015 All Rights Reserved
Encounter Data – Patient Location
© Atlantic Health System, Inc. 2015 All Rights Reserved
Encounter Data – Service
© Atlantic Health System, Inc. 2015 All Rights Reserved
Encounter Data – Diabetic
Diabetic Patients Non‐Diabetic PatientsDiabetic Patients Non Diabetic Patients
© Atlantic Health System, Inc. 2015 All Rights Reserved
Encounter Data – Prescriber
© Atlantic Health System, Inc. 2015 All Rights Reserved
Physician Group
© Atlantic Health System, Inc. 2015 All Rights Reserved
Deployment of a Dashboard toDeployment of a Dashboard to Nursing Management
© Atlantic Health System, Inc. 2015 All Rights Reserved
Service Line Performance
© Atlantic Health System, Inc. 2015 All Rights Reserved
How Do You Ask Why?How Do You Ask Why?Measuring Process
Understanding outcomes and affecting change requires measuring the process
Investigations• Prandial Insulin use• Basal Insulin use• Basal Insulin dose changes• Overuse of sliding scale
© Atlantic Health System, Inc. 2015 All Rights Reserved
Finding the WhyFinding the WhyDigging into the Detail
Importing raw MAR and patient medication profile data turns this analytics software into an investigation tool
Matching account numbers on pivoted aggregation data allows diving in
George Hodan :: http://www.publicdomainpictures.net/view‐image.php?image=36643&picture=games‐on‐the‐beachGeo ge oda ttp // pub cdo a p ctu es et/ e age p p age 366 3&p ctu e ga es o t e beac
© Atlantic Health System, Inc. 2015 All Rights Reserved
Investigation Panel for Clinicians
© Atlantic Health System, Inc. 2015 All Rights Reserved
Future Process Measures
Electronic form Usage (data already available and integrated)
Appropriate Basal dose changes after correctional insulin use• Challenge: Capture correctional dose for day N and
prepare boolean (T/F) if basal dose is the same Timely administration of insulin
A i i i li ti l ?• Are we giving our insulin timely? Timely capture of BG measurement
• Are our BG measurements being performed too close to l ?meals?
Are we correcting insulin with Sliding Scale too often?• Percent administrations vs. POC checks
© Atlantic Health System, Inc. 2015 All Rights Reserved
The Road Ahead
Data Governance• Finalizing definitions and populations across the health
system• Organizing data sources so we are all using the same
information Analytics Infrastructure
• New hires• Reorganization• Culture of analyticsy• Very exciting!
© Atlantic Health System, Inc. 2015 All Rights Reserved
Success Measures
Initiative Measure Outcome
Cost Cost of Adverse Drug Events Not yet Cost Cost of Adverse Drug Events quantified
Quality Defect Rate Reduced!!y
Utilization Excess Days associated with poor glycemic control
Not yet quantified
Efficiency Data at everyone's fingertips when they want it Priceless!
© Atlantic Health System, Inc. 2015 All Rights Reserved
Q estions?Questions?
Carlo
ugh ©
n Ca
t :: M
iche
lle C
LinkedIn: www.linkedin.com/in/thomascarlough
Gwe
LinkedIn: www.linkedin.com/in/thomascarloughTwitter: @EtherAnalyticsEmail: [email protected]
© Atlantic Health System, Inc. 2015 All Rights Reserved
Images in this Presentation
All images in this presentation are within the public domain, many are sourced through http://www.publicdomainpictures.net
• I have no affiliation with this website but appreciate public domain and creative commons artists.
All graphs and visuals otherwise included were created by McKesson Performance Analytics ExplorerTMy p
© Atlantic Health System, Inc. 2015 All Rights Reserved
Thank YoThank You
LinkedIn: www.linkedin.com/in/thomascarloughTwitter: @EtherAnalyticsEmail: [email protected]
© Atlantic Health System, Inc. 2015 All Rights Reserved